Background: In emergency situations, patients and their next of kin must make complex medical and ethical decisions in a quick and timely way. Methods: In-depth interviews were conducted among 22 patients and 17 next of kin of patients who had undergone emergency surgery within 24 -72hrs at two tertiary teaching hospitals. Responses about decision-making were coded into four themes; decision makers, people consulted, documentation of the consent, and factors influencing decision making. Results: Most patients and next of kin made decisions on their own and personally documented the consent for themselves or their patient for the next of kin. Other family members and doctors were consulted during the decision-making process. Decision making was influenced by assurance of good outcomes of surgery and disclosure by the doctors. Conclusion: Decisions were made collaboratively with the patient at the centre but with input from health personnel, the next of kin, and other family members.